Prevalence, measurement and implications of frailty in stroke survivors: an analysis of three global aging cohorts

Hanlon, P. , Burton, J. K. , Quinn, T. J. , Mair, F. S. , McAllister, D. , Lewsey, J. and Gallacher, K. I. (2023) Prevalence, measurement and implications of frailty in stroke survivors: an analysis of three global aging cohorts. International Journal of Stroke, 18(6), pp. 720-727. (doi: 10.1177/17474930231151847) (PMID:36621981) (PMCID:PMC10311928)

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Abstract

Background: Our understanding of the relationship between frailty and stroke, beyond the acute phase of stroke, is limited. We aimed to estimate the prevalence of frailty in stroke survivors using differing methods of assessment and describe relationships with stroke outcomes. Methods: We used data from three international population surveys (American Health and Retirement Survey/English Longitudinal Study of Ageing/Survey for Health and Retirement in Europe) of ageing. Frailty status was assessed using the Fried frailty phenotype, a 40-item frailty index (FI) and the clinical frailty scale (CFS). We created estimates of frailty prevalence and assessed association of frailty with outcomes of mortality/hospital admission/recurrent stroke at 2 years follow-up using logistic regression models adjusted for age/sex. Additional analyses explored effects of adding cognitive measures to frailty assessments and of missing grip strength data. Findings: Across 9617 stroke survivors, using the frailty phenotype, 23.8% (n=2094) identified as frail; with CFS 30.1% (n=2906) were moderately or severely frail; using FI, 22.7% (n=2147) had moderate frailty and 31.9% (n=3021) severe frailty. Frailty was associated with increased risk of mortality/hospitalization/recurrent stroke using all three measures. Adding cognitive variables to the frailty index produced minimal difference in prevalence of frailty. People with physical frailty (phenotype or CFS) plus cognitive impairment had a greater risk of mortality than people with an equivalent level of frailty but no cognitive impairment. Excluding people unable to provide grip strength underestimated frailty prevalence. Interpretation: Frailty is common in stroke and associated with poor outcomes, regardless of measure used. Adding cognitive variables to frailty phenotype/CFS measures identified those at greater risk of poor outcomes. Physical and cognitive impairments in stroke survivors do not preclude frailty assessment.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Professor David and Quinn, Professor Terry and Hanlon, Dr Peter and Gallacher, Dr Katie and Lewsey, Professor Jim and Burton, Dr Jenni and Mair, Professor Frances
Authors: Hanlon, P., Burton, J. K., Quinn, T. J., Mair, F. S., McAllister, D., Lewsey, J., and Gallacher, K. I.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:International Journal of Stroke
Publisher:SAGE Publications
ISSN:1747-4930
ISSN (Online):1747-4949
Published Online:09 January 2023
Copyright Holders:Copyright © 2023 World Stroke Organization
First Published:First published in International Journal of Stroke 18(6):720-727
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
305232Understanding prevalence and impact of frailty in chronic illness and implications for clinical managementFrances MairMedical Research Council (MRC)MR/S021949/1HW - General Practice and Primary Care